Step 3 – Vitamins

Balancing Your Vitamins

Congratulations, you are doing great!

Now that you are cleansing with increased hydration, you are probably wondering about vitamin supplements, what benefit do they provide and what do they have to do with back pain.

In this section, I will go through the vitamins that have an effect on neck, back and nerve pain and discuss some aspects of each vitamin. At the end, I will give some very general recommendations about vitamin supplements and steps to implement.

There is certainly scientific evidence to show that lack of some vitamins and minerals can cause nonspecific musculoskeletal back and neck pain. There is also data that shows that some vitamin deficiencies in our population are common and need to be supplemented. There are many possible reasons for these deficiencies. Deficiencies may occur on the supply side, as well as the uptake side of the equation.

Supply

On the supply side, the lack of dietary diversity is one reason, especially as we have moved more in the direction of consuming more processed foods and meats, which simply don’t contain the nutrients we need. Simply put, the foods we are eating may not contain sufficient quantities of bio-nutrients. The calories are there, but the nutrition is not. Whether this is a result of genetic manipulation, farming techniques that deplete the soil of its nutrients, processing techniques or some combination thereof, is yet to be determined.

Uptake

On the uptake side of the equation is absorption, which occurs in the stomach and intestines and varies from person to person but certainly doesn’t get better with age and can be affected by medications taken or diseases that are present. Regardless, the vitamins and nutrients must be present in sufficient quantity to be absorbed.

Certain environmental aspects may play a part, like sun light exposure, that affects your synthesis of vitamin D. You may be taking a medicine that depletes a certain vitamin. You might have a disease that interferes with absorption of a particular nutrient. It is unusual for a traditional physician to order blood tests to check circulating vitamin levels, so the awareness is not really there. You don’t have to have a drastic deficiency of something to start manifesting symptoms, an insufficiency will do.

The point is that there are vitamin group deficiencies that can cause pain in the back or neck, or tingling of extremities. Fortunately most of these deficiencies can be easy to solve by taking a supplement or vitamin injection. Remember the two sides of this equation, the supply side and the uptake ability side.

Let’s say one takes a vitamin, well there is no guarantee that it is 100% bio-available. There may be issues with content, potency, bio-availability and absorption, which are all topics unto themselves.

– Was there an independent lab that tested the bio-availability of the vitamin supplement?

– Does it make any difference if the vitamin is synthetic or was generated from plant material?

– Are liquid vitamins better absorbed than pills?

These are all valid questions, however beyond the scope of this program, which is why I recommend checking out www.Consumerlab.com which is an independent laboratory discussing these issues regularly.

Vitamin B1 (Thiamine)

What a deficiency means to you is impaired nerve function (neuritis/inflammation), particularly of the peripheral sensory and motor nerves. This water-soluble vitamin was the first vitamin discovered. It was isolated in 1911. A deficiency of thiamine causes Beriberi, a neurological and cardiovascular disease. Incidence of thiamine deficiency is rare in the US.

How much do I need?

Recommended Daily Allowance (RDA) is usually 1.4 milligrams/day to prevent beriberi.

One study showed more mental acuteness in women when women took 50 mg/day. Of note, was a study that showed that extra thiamine was not that helpful unless refined sugar was restricted!

Ways to get it:

Vitamin B1 is synthesized in bacteria, fungi and plants, so we must get it from our diet or supplements. Whole grains contain more than refined grains, since most of the thiamine is contained in the outer layers of the grain and in the germ, which are removed during the refining process. This necessitates enriching processed flour with thiamine.

Good sources are oatmeal, flax, sunflower seeds, brown rice, whole grain rye, asparagus, kale, cauliflower, potato, oranges, liver and eggs.

Measurement is done with a blood test.

Vitamin B6 (Pyridoxine)

What a deficiency means to you, is that nerve function may be impaired, and cause tingling, numbness, pain, wearing an Dzinvisibledz glove, burning, freezing, extreme sensitivity or electrical shock-like symptoms.

This water-soluble vitamin is important for amino acid metabolism, neurotransmitter synthesis (serotonin, epinephrine, norepinephrine and gamma-aminobutyric acid) and the release of glucose from glycogen.

Incidence of deficiency is quite rare, but can occur in elderly, people undergoing renal dialysis, and in alcoholics. Also those with liver disease and rheumatoid arthritis may be at risk.  Medications such as corticosteroids and anticonvulsants may diminish the availability of vitamin B6 to the body.

How much do I need?

RDA is 1.3-1.7 mg. Taking 100mg/day as an adult is probably the upper limit. Too much vitamin B6 can cause many of the same symptoms as a deficiency!

Ways to get it:

Best sources are vegetables (carrots, spinach,peas, baked potato), nuts, bananas, whole grain products and meats (chicken). Cooking, storage, and processing all decrease the vitamin B6 content.

Measurement – PLP (plasma pyridoxal phosphate) can be used to measure.

Vitamin B12 (Cobalmin)

What a deficiency means to you, Neurological (diminished sense of touch, very annoying and persistent paresthesias or needles and pins sensation, gastrointestinal, and anemia symptoms characterize a deficiency of Vitamin B12.

At Vitamin B12 levels that are slightly lower than normal, symptoms such as fatigue, depression may occur.

Vitamin B12 or cobalmin is water soluble and essential for the normal function of the brain and nervous system and the formation of blood.

How much do I need?

RDA is 2-3 mcg/day. A deficiency state may be more common than previously thought, in the US a study done by Tufts University of 3000 showed that 39% had low values! Vegetarians and vegans are also at risk if they don’t take B12 supplements, so babies of these mothers may need to have their B12 levels assessed. The elderly are at even more risk.

How to get it:

Meat, fish, poultry, eggs, milk, and foods fortified with vitamin B12.  Vitamin B12 can be supplemented with sublingual pills, intranasal sprays, transdermal patches or injectable preparations (subcutaneous or IM). Oral treatments involve giving 250 mcg to 1 mg daily. Oral mega doses are considered to be 1-2 mg. There isn’t much to show that sublingual (under the tongue) or lollipop preparations are much better absorbed than large oral doses. Injection doses would be in the amount of 1-2 mg on a monthly basis, but probably not necessary if sufficient oral doses are taken.

Measurement – The measurement of urine methylmalonic acid seems to correlate fairly well with serum B12 levels, but is not as reliable in the elderly. Methlymalonic acid requires vitamin B12 to be metabolized, so a low level of B12 will give rise to a elevated level of methlymalonic acid in the urine.

Vitamin C (ascorbic acid)

Essential for collagen production. What does a deficiency means to you? A very rare example of vitamin C deficiency, in western culture, is scurvy.

Deficiency will result in defective connective issue, collagen synthesis and structural stability. It is hypothesized that deficiency may be a key-contributing factor to the development of degenerative disc disease in the elderly, and once the process begins, the tissue inflammation that accompanies the DDD may even require more Vitamin C, as vitamin C is a powerful antioxidant. Muscle myalgia may also be present if low vitamin C levels lead to reduced carnitine levels. Vitamin C or ascorbic acid is an essential nutrient that acts mainly as an antioxidant and a cofactor in many enzymatic reactions including several collagen synthesis reactions.

How much do I need?

The RDI ranges between 45-95 mg/day, so 100mg /day is sufficient for men and women and much above 200mg doesn’t seem to be absorbed. Although many people take much larger doses of vitamin C, the evidence for doing so is very weak unless there is a deficiency.

Ways to get it:

Fruits (especially citrus), vegetables (broccoli, green peppers, leafy greens, and tomatoes), fish, legumes and root crops (potatoes).

The Linus Pauling Institute at Oregon State University does not note any difference between taking synthetic and natural ascorbic acid. If gastrointestinal upset occurs from pure ascorbic acid, one may try one of the many mineral preparations, which are often buffered and easier on the stomach. These include potassium, magnesium, zinc, molybdenum, chromium and manganese combined with ascorbate.

Vitamin D

What does it mean to you? There is a positive correlation between vitamin D deficiency and a variety of nonspecific bone pain, particularly in women. Bone pain can be felt almost anywhere in the skeletal system, so pain can be felt in legs, joints (large and small), ribs and back. Who knows how much fibromyalgia type of pain may originate from this vitamin deficiency?

The American Family Physician reports that vitamin D affects persons of all ages with common manifestations of symmetric low back pain, and muscle aches. Incidence of Vitamin D insufficiency is not rare! It is highest in the elderly or hospitalized, but a group of 77 people studied in Boston with no known risk factors and a mean age of 44 + or –14 years was 57%! Insufficiency is also reported with obesity.

Vitamin D is a fat-soluble vitamin that is essential for maintaining normal calcium metabolism and balance. Vitamin D3 is synthesized in the skin upon exposure to ultraviolet-B waves from the sun. Plants synthesize vitamin D2 with exposure to ultraviolet light. If we don’t generate enough vitamin D, we need to get it from our diet or take a supplement. The mechanisms of action are complex and widespread throughout the body.

Vitamin D modulates calcium levels by:

  • Mobilizing calcium from the bon
  • Increasing intestinal absorption of calcium
  • Increasing the re-absorption of calcium in the kidneys.

According to the Linus Pauling Institute, vitamin D also plays an important role in:

  • Controlling cell proliferation and differentiation (may have some relation to cancer)
  • Immunity and autoimmunity may be influenced
  • Affecting insulin secretion
  • Blood pressure regulation
  • Reduction of inflammation

How much do I need?

RDA is 600 IU/day < age 70, and 800 IU/day > age 70 years. There are many respected sources on this topic including the (IOM) Institute of Medicine, a non-profit organization connected to the National Academy of Science, who recently raised their daily recommendations. The problem is that one size does not fit all because of age, sun exposure, dietary habits, and individual metabolism. The good news is that the intake of a very adequate amount will almost ensure adequate blood levels, but never approach toxicity.

Treatment

Age is important. 600-1500 IU cholecalciferol (vit D3) /day for adults less than 70 years for maintenance. 800-2000 IU/ day cholecalciferol (vit D3) for those over age 70 for maintenance. Deficiencies and insufficiencies are probably best managed by your treating doctor.

Ways to get it:

Sources include fatty fish, eggs, cod liver oil, and ultraviolet rays from sun vary for latitude (north/south)and season of the year.

Measurement – A deficiency is measured with a blood test to measure serum levels. A level of 25-hydroxyvitamin D < 20ng/ ml is deficient and insufficiency would be level of 20-30 ng /ml.

Get this blood test to check to if what you are doing is adequate, during or after treatment.

Minerals

If you are eating a good diet (next section), even without taking a good supplement, you will most likely have adequate mineral levels.

Otherwise most vitamin supplement preparations have minerals included.

Action Steps

Step 1

Think About What You Are Going to Eat.

This is a great time to start thinking about what you are eating. The reason I say this is because our diet and exposure to sunlight should give us the vitamins that we need without supplementation. Increasing the leafy dark green aspect of our diet will go a long way to reducing our need for supplementation. Vitamins in a natural vegetable form are easy to absorb as well.

Step 2

Look at the Label.

If you are taking a multi vitamin now, Look at the Label and check which vitamins are contained in your preparation. Next, check that sufficient quantities are there.

Vitamin B 12 – Most multi vitamins have between 25-100 mcg.

Difficult to calculate, since the daily requirement is 2 mcg, yet you may need as much as 500-1000 mcg daily for treatment of a deficiency since absorption is so variable. Adequate B12 amounts almost assure adequate levels of B1 and B6.

Vitamin C – Anything > 100 mg.

Vitamin D3 – 600 IU if older than 70 years, 800 if not.

Vitamin supplements can be taken at any time, but read the bottle and see how often you are supposed to take them. Taking vitamins with meals might help with any stomach discomfort. Don’t forget that there are some fantastic liquid preparations as well.

Step 3

Check For The Right Preparation.

Look at www.ConsumerLab.com to see an independent laboratory assessment of what you are taking or to help you find the right preparation.

Step 4

Utilize Appropriate Lab Tests.

If you have any reason to think that you have a vitamin deficiency (obesity, chronic disease e.g. diabetes, or taking amedication that can deplete a vitamin store like anti-convulsants or steroids) ask your doctor to order the appropriate lab test to check your vitamin levels.